One of the current trends in vocational rehabilitation is the job coach program. In this program, memory disabled individuals (for example, head injury patients) are placed on the job with a professional coach. The coach stays on the job as long as needed (often many months) until the patient learns enough skill to stay on the job with normal supervision. The justification for the job coach program is that it is less expensive than extensive pre-vocational and patient custodial treatment, especially since the patient and coach team is paid for the joint job. Of course, the coach is a professional trained in rehabilitation and must command a competitive wage for the professional service being performed. Hence, means of extending the reach of the coach to multiple patients is constantly being sought.
With some success, certain patients can be given less supervision by the combined use of an alarm watch and a notebook containing their daily schedule. A patient that can rely on this simple memory aid system is well along. There are many less fortunate patients. Typically, they do not associate the alarm signals with the need to scan their schedules in their notebooks. Also, they may have difficulty with selecting the appropriate written cue from a list of tasks. A number of supported employment programs involving private employers have used "walkman" type tape players to sequentially present vocal job instructions for patients with mild retardation or attentional deficits. This aid is most useful for a repetitive job such as clearing tables. Some attempts have been made to use personal computers dedicated to patients to direct them through a series of tasks. These cuing systems can provide timed, sequential, verbal or printed cues to the patient and may or may not include patient operated means to sense whether the cues have been heeded. In many cases, the patient cannot be relied upon to acknowledge all of the cues and, therefore, can easily be confused by cues or instructions that are given at the wrong time or in the wrong location.
Helping patients with memory, attention or perceptual impairments or a combination thereof to increase autonomy in the activities of daily living (ADL), either at home or in institutional settings, is every bit as important as helping similar patients to enter the work place. These individuals also can benefit from training aids that will not give cues or instructions at the wrong time or place.